The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up LTFU from an antiretroviral therapy ART clinic in Nairobi, Kenya.

Design

The study used a prospective cohort of patients who participated in a randomized, controlled ART adherence trial between 2006 and 2008.

Methods

Participants were followed from pre-ART clinic enrollment to 18 months after ART initiation, and were defined as LTFU if they failed to return to clinic 4 weeks after their last scheduled visit. Reasons for loss were captured through phone call or home visit. Characteristics of LTFU who transferred care and LTFU who did not transfer were compared to those who remained in clinic using log-binomial regression to estimate risk ratios.

Results

Of 393 enrolled participants, total attrition was 83 21%, of whom 75 90% were successfully traced. Thirty-seven 49% were alive at tracing and 22 59% of these reported having transferred their antiretroviral care. In the final model, transfers were more likely to have salaried employment Risk Ratio RR, 2.7; 95% confidence interval CI, 1.2-6.1; p=0.020 and pay a higher monthly rent RR, 5.8; 95% CI, 1.3-25.0; p=0.018 compared to those retained in clinic. LTFU who did not transfer care were three times as likely to be men RR, 3.1; 95% CI, 1.1-8.1; p=0.028 and nearly 4 times as likely to have a primary education or less RR, 3.8; 95% CI, 1.3-10.6; p=0.013. Overall, the most common reason for LTFU was moving residence, predominantly due to job loss or change in employment.

Conclusion

A broad definition of LTFU may include those who have transferred their antiretroviral care and thereby overestimate negative effects on ART continuation. Interventions targeting men and considering mobility due to employment may improve retention in urban African ART clinics.